Southmead Hospital redevolpment programme & SWWE branch AGM

The North Bristol NHS Trust kindly hosted the SWWE Branch AGM at their new Learning and Research Building, which is a recently completed part of the Southmead Hospital redevelopment programme.

Martin Gosden, the branch Chairman, conducted a brisk AGM which saw the re-election of the committee (introduction to the committee, agreement of the 2011 AGM minutes, review of the past year and looking forward to the next were amongst the items discussed). In addition, Martin also presented the financial statement on behalf of Peter Wakeling, the branch Treasurer, which was approved.

The Chairman also welcomed Mr Harry Hayer, Director Organisation, People and Performance, who provided the audience with an introduction to the NHS and the Southmead development programme.

The NHS is the 4th largest organisations in the world, with 1.7 Million staff, providing free at the point of delivery health care for 62 million customers. Despite this, the current financial climate is presenting real challenges to improve productivity and efficiency. The Bristol NHS Estate is one of the worst in the UK, with very old and poor buildings. The Southmead redevelopment is not just about building state of the art facilities, but also completely redesigning and implementing new ways of working. Programme and Project Management has been critical to the successful management and delivery of the programme.

Tricia Down, the Programme Director, outlined the approach to the construction project of the programme which is due for completion 2015. A PFI procurement approach has been taken to fund the 430 M project. Stage 1 completes March 2014 with the handover of the Hospital building, and Stage 2, in 2015, with completion of landscaping, roads and car parks.

The programme represented a major challenge to obtain experience of PFI deals and to secure the necessary PPM skills. A lot of time was spent in planning, learning of others experiences and mistakes, to be able to develop a good quality requirement for the building. The small project team, 10-12 staff focus much of their effort on controlling the management of variation. A policy of only agreeing changes if they are traded off to keep within budget has been very successfully applied, keeping the construction project and the overall programme to time and budget.

Stakeholder management has been key, ensuring the views of the patients, staff and local community have been accounted for. A focus on sustainability has reduced the energy costs to half that of a typical hospital. Flexibility of design will enable change of use to be readily and cheaply managed in the future.Tricia highlighted some of the key lessons: the importance of team values and working; the need to enforce PPM skills and discipline; management of variation buy documented process and pinning down the detail before contract signature; and the need to actively manage external influences, such as the NHS approvals process.

Corrina Casey, Senior Programme Manager, outlined the challenges of redesigning the ways of working projects. The new Southmead has fewer beds, all in single rooms and not wards, as care is transferred to outpatients and in home care. Frenchay services and staff are being transferred to Southmead, and staff ways of working are changing, from nursing to consultants.

An innovative approach has been taken to the ways of working redesign, called Pathways, which looks at the patient experience at every stage of the their journey through hospital. To get stakeholder buy-in, multidisciplinary teams have been used to develop the patient pathways. The ultimate aim is to have exceptional healthcare, personally delivered.

To manage the programme, a PMO was set up and a disciplined PjM approach applied based on Prince 2.Corrinas lessons highlighted the immaturity of PPM skills in the NHS, and the effort needed to raise them with the majority of resources being from internal staff. There was a lot of push back earlier, and a poor response to applying PPM discipline. A decision was taken to bring in some external expertise, but his did mean the internal change ambassadors were lost. Corrina felt that on reflection, it would have been better to persevere and up skill the internal resources.

Cathy Meredith, Change Management Leader, outlined the challenges with implementing the changes. It was all about communication and engagement, taking the 9500 people with them from Southmead, Frenchay and community workers, to change the ways of working. They key was to empower staff to lead the change, but it was first necessary to overcome cynicism and change overload.

A detailed stakeholder management and communication plan was developed, which segmented stakeholders into the need for awareness for all, with 6 month surveys to check the right messages were being received, key influencers (the message carriers), unofficial influencers, the rumour mongers, the porters, junior doctors, and decision makers, the patients, GPs and health commissioning professionals. The results from the surveys have been getting progressively better, with 68% being ware and 20% confident of of the results. This work is underpinning the successful handover of the building in 2014 and the move in of 9500 staff with new ways of working.

The Southmead redevelopment is a very complex programme and the speakers provided a real insight into how such complexity can be managed to deliver the expected benefits.

The evening was rounded off with networking and the chance to quiz the Southmead team in more detail over a buffet and drinks.